Journal articles on the topic 'Health administrations'
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Baumann, Aron, and Kaspar Wyss. "Exploring evidence use and capacity for health services management and planning in Swiss health administrations: A mixed-method interview study." PLOS ONE 19, no. 5 (May 8, 2024): e0302864. http://dx.doi.org/10.1371/journal.pone.0302864.
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Background Health administrations require evidence, meaning robust information, data, and research, on health services and systems. Little is known about the resources and processes available within administrations to support evidence-informed policymaking. This study assessed Swiss health administrations’ capacity for evidence use and investigated civil servants’ needs and perspectives regarding the role and use of evidence in health services management and planning. Methods In this mixed-method study, we interviewed civil servants from Swiss German-speaking cantonal health administrations. We quantitatively assessed administrations’ organization-level capacity by applying six structured interviews using an existing measurement tool (ORACLe). Individual-level needs and perspectives regarding evidence use and capacity were qualitatively explored with twelve in-depth interviews that were analyzed using the framework method. Findings Respondents indicated moderate evidence-use capacity in all administrations. Administrations displayed a similar pattern of high and low capacity in specific capacity areas, generally with considerable variation within administrations. Most administrations indicated high capacity for producing or commissioning evidence and close relationships with research. They showed limited capacity in the documentation of processes and availability of tools, programs, or training opportunities. Administrations place the responsibility for engagement with evidence at the level of individual civil servants rather than at the organizational level. Although administrations highly value evidence-informed policymaking and consider it vital to effective health services management and planning, they face significant constraints in accessing evidence-specific resources and receive little organizational support. Administrations rely on external capacity to compensate for these limitations and engage with evidence pragmatically. Conclusion Our findings indicate moderate and improvable capacity for evidence use in Swiss health administrations that place limited value on organizational support. Besides strengthening organizational support, leadership buy-in, particular staff needs, and balancing the implementation of specific measures with the provision of more general resources should be considered to unlock the potential of strengthened engagement with evidence.
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van der Veen, Willem, Patricia MLA van den Bemt, Hans Wouters, David W. Bates, Jos WR Twisk, Johan J. de Gier, Katja Taxis, et al. "Association between workarounds and medication administration errors in bar-code-assisted medication administration in hospitals." Journal of the American Medical Informatics Association 25, no. 4 (August 22, 2017): 385–92. http://dx.doi.org/10.1093/jamia/ocx077.
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Abstract Objective To study the association of workarounds with medication administration errors using barcode-assisted medication administration (BCMA), and to determine the frequency and types of workarounds and medication administration errors. Materials and Methods A prospective observational study in Dutch hospitals using BCMA to administer medication. Direct observation was used to collect data. Primary outcome measure was the proportion of medication administrations with one or more medication administration errors. Secondary outcome was the frequency and types of workarounds and medication administration errors. Univariate and multivariate multilevel logistic regression analysis were used to assess the association between workarounds and medication administration errors. Descriptive statistics were used for the secondary outcomes. Results We included 5793 medication administrations for 1230 inpatients. Workarounds were associated with medication administration errors (adjusted odds ratio 3.06 [95% CI: 2.49-3.78]). Most commonly, procedural workarounds were observed, such as not scanning at all (36%), not scanning patients because they did not wear a wristband (28%), incorrect medication scanning, multiple medication scanning, and ignoring alert signals (11%). Common types of medication administration errors were omissions (78%), administration of non-ordered drugs (8.0%), and wrong doses given (6.0%). Discussion Workarounds are associated with medication administration errors in hospitals using BCMA. These data suggest that BCMA needs more post-implementation evaluation if it is to achieve the intended benefits for medication safety. Conclusion In hospitals using barcode-assisted medication administration, workarounds occurred in 66% of medication administrations and were associated with large numbers of medication administration errors.
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Loput, Charity M., Connie L. Saltsman, Risa C. Rahm, Wm Dan Roberts, Sanya Sharma, Cindy Borum, and Jennifer A. Casey. "Evaluation of medication administration timing variance using information from a large health system’s clinical data warehouse." American Journal of Health-System Pharmacy 79, Supplement_1 (October 15, 2021): S1—S7. http://dx.doi.org/10.1093/ajhp/zxab378.
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Abstract Purpose An analysis to determine the frequency of medication administration timing variances for specific therapeutic classes of high-risk medications using data extracted from a health-system clinical data warehouse (CDW) is presented. Methods This multicenter retrospective, observational analysis of medication administration data from 14 hospitals over 1 year was conducted using a large enterprise health-system CDW. The primary objective was to assess medication administration timing variance for focused therapeutic classes using medication orders and electronic medication administration records data extracted from the electronic health record (EHR). Administration timing variance patterns between standard hospital staffing shifts, within therapeutic drug classes, and for as-needed (PRN) medications were also studied. To assess medication administration timing variance, calculated variables were created for time intervals of 30-59, 60-120, and greater than 120 minutes. Scheduled medications were assessed for delayed administration and PRN medications for early administration. Results A total of 5,690,770 medication administrations (3,418,275 scheduled and 2,272,495 PRN) were included in the normalized data set. Scheduled medications were frequently subject to delays of ≥60 minutes (15% of administrations, n = 275,257) when scheduled for administration between 9-10 AM and between 9-10 PM. By therapeutic drug class, scheduled administrations of insulins, heparin products, and platelet aggregation inhibitors were the most commonly delayed. For PRN medications, medications in the anticoagulant and antiplatelet agent class (most commonly heparin flushes and line-management preparations) were most likely to be administered early, defined as more than 60 minutes from the scheduled time of first administration. Conclusion The findings of this study assist in understanding patterns of delayed medication administration. Medication class, time of day of scheduled administration, and frequency were factors that influenced medication administration timing variance.
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Leslie, Eric, Eric Pittman, Brendon Drew, and Benjamin Walrath. "Ketamine Use in Operation Enduring Freedom." Military Medicine 186, no. 7-8 (July 1, 2021): e720-e725. http://dx.doi.org/10.1093/milmed/usab117.
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ABSTRACT Introduction Ketamine is a dissociative anesthetic increasingly used in the prehospital and battlefield environment. As an analgesic, it has been shown to have comparable effects to opioids. In 2012, the Defense Health Board advised the Joint Trauma System to update the Tactical Combat Casualty Care Guidelines to include ketamine as an acceptable first line agent for pain control on the battlefield. The goal of this study was to investigate trends in the use of ketamine during Operation Enduring Freedom (OEF) and Operation Freedom’s Sentinel (OFS) during the years 2011-2016. Materials and Methods A retrospective review of Department of Defense Trauma Registry (DoDTR) data was performed for all patients receiving ketamine during OEF/OFS in 2011-2016. Prevalence of ketamine use, absolute use, mechanism of injury, demographics, injury severity score, provider type, and co-administration rates of various medications and blood products were evaluated. Results Total number of administrations during the study period was 866. Ketamine administration during OEF/OFS increased during the years 2011-2013 (28 patient administrations in 2011, 264 administrations in 2012, and 389 administrations in 2013). A decline in absolute use was noted from 2014 to 2016 (98 administrations in 2014, 41 administrations in 2015, and 46 administrations in 2016). The frequency of battlefield ketamine use increased from 0.4% to 11.3% for combat injuries sustained in OEF/OFS from 2011 to 2016. Explosives (51%) and penetrating trauma (39%) were the most common pattern of injury in which ketamine was administered. Ketamine was co-administered with fentanyl (34.4%), morphine (26.2%), midazolam (23.1%), tranexamic acid (12.3%), plasma (10.3%), and packed red blood cells (18.5%). Conclusions This study demonstrates increasing use of ketamine by the U.S. Military on the battlefield and effectiveness of clinical practice guidelines in influencing practice patterns.
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Purssell, R., L. Mathany, M. Kuo, M. Otterstatter, J. Buxton, and R. Balshaw. "P105: BC’s public health emergency and naloxone administration by the BC Ambulance Service." CJEM 19, S1 (May 2017): S114. http://dx.doi.org/10.1017/cem.2017.307.
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Introduction: In 2015, there were 476 apparent illicit drug overdose deaths, prompting BC’s Provincial Health Officer to declare a public health emergency on 14 Apr 2016. Paramedics of BC’s Ambulance Service (BCAS) are on the front lines in this crisis. Here we examine recent trends in the number of suspected overdose events attended by the BCAS and the use of naloxone, an opioid antagonist, by BCAS paramedics. Methods: The BC Centre for Disease Control receives a weekly data feed from BC Emergency Health Services that includes all records from the BCAS Patient Care Record where: naloxone was administered by paramedics; the primary impression code indicates poisoning or overdose; or, the originating call is associated with ingestion poisoning (‘card 23’). Here, we report a descriptive analysis of these data for suspected drug overdose events during the period January 1, 2010 to September 30, 2016. Results: Between January 2010 and September 2016 BCAS paramedics attended 164,227 suspected overdose events; 12% of these events (n=16,944) included naloxone administration by BCAS paramedics. Paralleling the rise in illicit drug overdose deaths in BC, naloxone administration by paramedics has been increasing rapidly, doubling from approximately 180/month in 2014, to 370/month in 2016. When naloxone was administered by paramedics, 90% of these patients were transported, whereas 77% were transported when naloxone was not administered. Administrations occurred most frequently on Friday and Saturday evenings. Almost half (46%) of all naloxone administrations by paramedics were recorded as being in a home or residence; 18% were recorded as occurring on a street or highway. The proportion of naloxone administrations among males has increased yearly. In 2010, 58% of naloxone administrations were in males compared to 69% in 2016. Conclusion: The number of overdose deaths in BC has risen drastically in recent years and the proportion of ambulance calls requiring administration of naloxone by BCAS has climbed correspondingly. The vast majority of overdose cases-especially those requiring naloxone-are transported to the emergency department. With the overdose crisis showing little sign of abating, the administration of naloxone by BC paramedics will continue to be a critical element of the provincial response.
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Anselmi, Laura, Mylène Lagarde, and Kara Hanson. "The efficiency of the local health systems: investigating the roles of health administrations and health care providers." Health Economics, Policy and Law 13, no. 1 (May 2, 2017): 10–32. http://dx.doi.org/10.1017/s1744133117000068.
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AbstractThe analysis of efficiency in health care has largely focussed either on individual health care providers, or on sub-national health systems conceived as a unique decision-making unit. However, in hierarchically organized national health services, two separate entities are responsible for turning financial resources into services at the local level: health administrations and health care providers. Their separate roles and the one of health administrations in particular have not been explicitly considered in efficiency analysis. We applied stochastic frontier analysis to district-level panel data from Mozambique (2008-2011) to assess district efficiency in delivering outpatient care. We first assessed the efficiency of the whole district considered as an individual decision-making unit, and then we assessed separately the efficiency of health administrations and health care providers within the same district. We found that on average only 73% of the outpatient consultations deliverable using available inputs were realized, with large differences in performance across districts. Individual districts performed differently in administrative or health care delivery functions. On average, a reduction of administrative inefficiency by 10 percentage points, for a given expenditure would increase by 0.2% the volume of services delivered per thousand population per year. Identifying and targeting the specific drivers of administrative inefficiencies can contribute to increase service.
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Ngwa, Canute A., and Christian Asongwe. "The British Southern Cameroons Health Services as an Appendage to Nigerian Health Sector, 1922-1961." International Journal of Scientific Research and Management 8, no. 03 (March 4, 2020): 638–44. http://dx.doi.org/10.18535/ijsrm/v8i03.sh01.
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The incidence of disease on the colonial agenda triggered the development of healthcare services by colonial administrations in Africa. In Southern Cameroons, the British administration fashioned a medical policy whose implementation spanned from 1922 to 1930. Informed by the colonial imperative, administrative and medical officers developed medical infrastructure, trained and engaged personnel, conducted research, and made efforts to roll back the incidence of various diseases. This took curative and preventive forms in a context of conflicting agendas, colonial arrogance, cultural ignorance, and defective infrastructure and personnel. The outcomes were beneficial to the colonial enterprise and detrimental to the economic wellbeing of the local population, the incidental benefits notwithstanding.
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Elnitsky, Christine, Martha Bryan, and Robert D. Kerns. "Veterans Health Administrations pain research portfolio and publications." Journal of Rehabilitation Research and Development 44, no. 2 (2007): xi. http://dx.doi.org/10.1682/jrrd.2007.04.0056.
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Turingan, Erin M., Bijan C. Mekoba, Samuel M. Eberwein, Patricia A. Roberts, Ashley L. Pappas, Jennifer L. Cruz, and Lindsey B. Amerine. "Financial Effect of a Drug Distribution Model Change on a Health System." Hospital Pharmacy 52, no. 6 (June 2017): 422–27. http://dx.doi.org/10.1177/0018578717717379.
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Background: Drug manufacturers change distribution models based on patient safety and product integrity needs. These model changes can limit health-system access to medications, and the financial impact on health systems can be significant. Objective: The primary aim of this study was to determine the health-system financial impact of a manufacturer’s change from open to limited distribution for bevacizumab (Avastin), rituximab (Rituxan), and trastuzumab (Herceptin). The secondary aim was to identify opportunities to shift administration to outpatient settings to support formulary change. Methods: To assess the financial impact on the health system, the cost minus discount was applied to total drug expenditure during a 1-year period after the distribution model change. The opportunity analysis was conducted for three institutions within the health system through chart review of each inpatient administration. Opportunity cost was the sum of the inpatient administration cost and outpatient administration margin. Results: The total drug expenditure for the study period was $26 427 263. By applying the cost minus discount, the financial effect of the distribution model change was $1 393 606. A total of 387 administrations were determined to be opportunities to be shifted to the outpatient setting. During the study period, the total opportunity cost was $1 766 049. Conclusion: Drug expenditure increased for the health system due to the drug distribution model change and loss of cost minus discount. The opportunity cost of shifting inpatient administrations could offset the increase in expenditure. It is recommended to restrict bevacizumab, rituximab, and trastuzumab through Pharmacy & Therapeutics Committees to outpatient use where clinically appropriate.
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Zinkevych, V. "Problems of the legal status of military administrations." Uzhhorod National University Herald. Series: Law 2, no. 79 (October 25, 2023): 64–68. http://dx.doi.org/10.24144/2307-3322.2023.79.2.9.
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The article examines the grounds and procedure for the formation of military administrations on the basis of local state administrations in the context of the legal regime of martial law. The legislative and encyclopedic definition of the term «military administration» is provided. Various approaches to the interpretation of legislation in the field of local self-government and the legal regime of martial law are analyzed using the example of the order of the head of the Chervonograd District Military Administration to terminate the powers of the district council. The innovations in the legislation of Ukraine that came into force after February 24, 2022 and concern military administrations and local self-government bodies are described. The differences in the formation of military administrations at the level of oblasts, districts, and settlements were analyzed; the role of military administrations during the war. The need for a clearer demarcation of the powers of military administrations, their chiefs and local self-government bodies and heads of communities was revealed. The article identifies common features of military and military-civilian administrations. The article also examines the legal status of military administrations in the context of the ratio of functions and responsibilities of local self- government bodies, which are not clearly demarcated and not regulated by law. This situation endangers the achievements of the decentralization reform in the context of the decentralization of powers and responsibilities. However, the existing legal status of military administrations, despite the challenges and problems described in the material, allows them to perform tasks related to the real preservation of life and health of the residents of communities. The work also raises the dubiousness of the legislative formulation of the grounds for terminating the authority of a local self-government body, as «actual failure to exercise authority», which is an assessment category without defined criteria for actual failure to exercise authority. The lack of detail, the non-fulfillment of which scope of authority is the reason for the termination of authority creates the conditions for the manual one-man decision by the President on the formation of a military administration.
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Stuessy, Peter, Federico Augusto Sanchez, and Madeline Schober. "Retrospective review of pegfilgrastim on-body injector delivery rates in a large health system." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e18273-e18273. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e18273.
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e18273 Background: Pegfilgrastim is used in patients at significant risk for febrile neutropenia following myelosuppresive chemotherapy. Labeling for pegfilgrastim requires administration the day after administration of chemotherapy. The pegfilgrastim on-body injector allows for delivery at home, without having to return to the clinic. Rates of appropriate delivery of pegfilgrastim via the on-body injector have not been studied in large scale outside of controlled environments. This retrospective review investigates the rate of appropriate delivery of pegfilgrastim via the on-body injector in a large heath system. Methods: Reports were created listing monthly clinic administration of the pegfilgrastim on-body injector at nineteen outpatient cancer care clinics from July 1st, 2016 to December 31st, 2016. Patient charts were reviewed for reported non-delivery of the medication. Results: Three hundred eighty-nine injections from 149 patient charts were reviewed. Of these injections, eight were not delivered (non-delivered rate = 2.1%). Four other administrations resulted in only partial dose delivery or unknown if dose was delivered (partial/unknown rate = 1%), leading to a failure rate of 3.1 with an appropriate delivery rate of 96.9%. Conclusions: In one health system’s experience, 96.9% of pegfilgrastim on-body injector administrations were delivered as planned. A process for real time evaluation of delivery rates should be created to address the 3-4% non-delivered dosing.
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Moreda Sánchez, Elsa María, Esther Martínez Pastor, and Ricardo Vizcaíno Pérez. "Comunicación Institucional Intercultural para la Salud: desarrollo durante la primera década del siglo XXI = Intercultural Institutional Communication for Health: development during the first decade of the 21st century." REVISTA ESPAÑOLA DE COMUNICACIÓN EN SALUD 8, no. 1 (June 9, 2017): 54. http://dx.doi.org/10.20318/recs.2017.3606.
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Resumen: El trabajo analiza la Comunicación Institucional Intercultural para la Salud como objeto de estudio a partir de las campañas y materiales informativos y divulgativos (cartelería, dípticos y folletos) realizados por las Administraciones Públicas españolas y dirigidos a la población inmigrante durante la primera década del siglo XXI. El objetivo es describir el origen, desarrollo y características de la Comunicación Institucional Intercultural para la Salud. Para ello se ha realizado un análisis de contenido de los materiales, a través del cual se constata un interés creciente por desarrollar este tipo de comunicación durante el período de estudio, sobre todo a partir de 2005 y entre las Administraciones autonómicas que mayor número de inmigrantes registran. Además, existe cierta coincidencia de los temas abordados con algunas de las prioridades encontradas a nivel socio-sanitario. La Comunicación Institucional Intercultural para la Salud es una línea de investigación hasta ahora poco desarrollada en España, entre otras razones porque la Administración Pública española no ha intervenido como actor en el proceso comunicativo intercultural hasta el inicio del presente siglo.Palabras clave: Administración pública, Comunicación, Institucional, Inmigración, Intercultural, Salud Abstract: This paper presents a first analysis of the informational materials (posters, folded sheets and booklets) that Spanish Public Administrations have targeted to immigrants during the first decade of the current century with the ultimate goal of describing the origin, development and characteristics of the Public Administration’s Intercultural Health Communication. Through a content analysis of the materials, a growing interest in developing this type of communication, especially from 2005 and among the regional administrations that more immigrants record, is found. In addition, a relative coincidence among disease topics in materials and priorities found at socio-sanitary level is also detected. There exists a research field so far underdeveloped in Spain: Public Administration’s Intercultural Health Communication. It is an emerging field as it is only from 2000 when Public Administration in Spain starts to consolidate as a communicating actor in the intercultural context.Keywords: Public administration, Government, Communication, Immigrant, Intercultural, Health
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Hosking, Diane, Vanessa Danthiir, Ted Nettelbeck, and Carlene Wilson. "Assessing lifetime diet: reproducibility of a self-administered, non-quantitative FFQ." Public Health Nutrition 14, no. 5 (December 21, 2010): 801–8. http://dx.doi.org/10.1017/s1368980010003174.
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AbstractObjectiveTo demonstrate test–retest reliability (reproducibility) of a new self-administered lifetime diet questionnaire, with a focus on foods relevant to cognitive health in older age.DesignThe reproducibility of dietary recall over four or five life periods was assessed by administering the questionnaire at two time points to an older cohort. The period between questionnaire administrations was 7 weeks. Polychoric correlations measured the association between recall at time 1 and time 2 and the weightedκstatistic measured the level of recall agreement for food groups across the two administrations of the questionnaire.SettingAdelaide, South Australia.SubjectsFifty-two cognitively healthy, older-age, community-dwelling adults completed the Lifetime Diet Questionnaire; mean age 81·8 (sd4·4) years, range 70–90 years.ResultsThe questionnaire showed very good reproducibility in this sample with a mean polychoric correlation coefficient of 0·81 between administration at time 1 and time 2, and an average weightedκof 0·49 for the level of recall agreement between food groups.ConclusionsThe demonstrated reliability of this lifetime diet questionnaire makes it a useful tool to assess potential relationships between long-term dietary intake and later-age cognitive outcomes.
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Kaplan, Robert M. "Application of a General Health Policy Model in the American Health Care Crisis." Journal of the Royal Society of Medicine 86, no. 5 (May 1993): 277–81. http://dx.doi.org/10.1177/014107689308600512.
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There is near consensus that the US health care system requires reform. Only a quarter of the American public has faith in the current system. Health care was one of the major issues considered in the 1992 US presidential election and the search for innovative solutions has transcended administrations.
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Ford, Clyde D., Julie Killebrew, Penelope Fugitt, Janet Jacobsen, and Elizabeth M. Prystas. "Study of Medication Errors on a Community Hospital Oncology Ward." Journal of Oncology Practice 2, no. 4 (July 2006): 149–54. http://dx.doi.org/10.1200/jop.2006.2.4.149.
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Purpose Medication errors (MEs) have been a significant problem resulting in excessive patient morbidity and cost, especially for cancer chemotherapeutic agents. Although some progress has been made, ME measurement methods and prevention strategies remain important areas of research. Methods During a 2-year period (2003-2004), we conducted a prospective study on the oncology ward of a large community hospital, with the goals of (1) complete nurse reporting of observed medication administration errors (MAEs), (2) classifying observed MAEs, and (3) formulating improvement strategies. We also conducted a retrospective review of a randomly chosen sample of 200 chemotherapy orders to assess the appropriateness of ordering, dispensing, and administration. Results Our nurses reported 141 MAEs during the study period, for a reported rate of 0.04% of medication administrations. Twenty-one percent of these were order writing and transcribing errors, 38% were nurse or pharmacy dispensing errors, and 41% were nurse administration errors. Only three MAEs resulted in adverse drug events. Nurses were less likely to report MAEs that they felt were innocuous, especially late-arriving medications from the pharmacy. A retrospective review of 200 chemotherapy administrations found only one clear MAE, a miscalculated dose that should have been intercepted. Conclusions Significant reported MAE rates on our ward (0.04% of drug administrations and 0.03 MAEs/patient admission) appear to be relatively low due to application of current safety guidelines. An emphasis on studying MAEs at individual institutions is likely to result in meaningful process changes, improved efficiency of MAE reporting, and other benefits.
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Hakun, Jonathan G., Nelson A. Roque, Courtney R. Gerver, and Eric S. Cerino. "Ultra-brief Assessment of Working Memory Capacity: Ambulatory Assessment Study Using Smartphones." JMIR Formative Research 7 (January 27, 2023): e40188. http://dx.doi.org/10.2196/40188.
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Background The development of mobile technology with substantial computing power (ie, smartphones) has enabled the adaptation of performance-based cognitive assessments to remote administration and novel intensive longitudinal study designs (eg, measurement burst designs). Although an “ambulatory” cognitive assessment paradigm may provide new research opportunities, the adaptation of conventional measures to a mobile format conducive to intensive repeated measurement involves balancing measurement precision, administration time, and procedural consistency. Objective Across 3 studies, we adapted “complex span” tests of working memory capacity (WMC) for ultra-brief, smartphone-based administration and examined their reliability, sufficiency, and associations with full-length, laboratory-based computerized administrations. Methods In a laboratory-based setting, study 1 examined associations between ultra-brief smartphone adaptations of the operation span, symmetry span, and rotation span tasks and full-length computerized versions. In study 2, we conducted a 4-day ecological momentary assessment (EMA) study (4 assessments per day), where we examined the reliability of ultra-brief, ambulatory administrations of each task. In study 3, we conducted a 7-day EMA study (5 assessments per day) involving the ultra-brief rotation span task, where we examined reliability in the absence of extensive onboarding and training. Results Measurement models in study 1 suggest that comparable estimates of latent WMC can be recovered from ultra-brief complex span task performance on smartphones. Significant correlations between the ultra-brief tasks and respective full-length versions were observed in study 1 and 2, ranging from r=0.4 to r=0.57. Results of study 2 and study 3 suggest that reliable between-person estimates of operation span, symmetry span, rotation span, and latent WMC can be obtained in 2-3 ultra-brief administrations (equivalent to <1 day of testing in an EMA study design). The results of study 3 replicated our findings, showing that reliable between-person estimates of rotation span may be obtained in as few as 2 ultra-brief administrations in the absence of extensive onboarding and training. In addition, the modification of task parameterization for study 3 improved the estimates of reliability of within-person change. Conclusions Ultra-brief administration of complex span tasks on smartphones in a measurement burst design can generate highly reliable cross-sectional estimates of WMC. Considerations for future mobile cognitive assessment designs and parameterizations are discussed.
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Gusmano, Michael K., and Frank J. Thompson. "The Administrative Presidency, Waivers, and the Affordable Care Act." Journal of Health Politics, Policy and Law 45, no. 4 (March 11, 2020): 633–46. http://dx.doi.org/10.1215/03616878-8255553.
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Abstract Within the American system of shared power among institutions, the executive branch has played an increasingly prominent policy role relative to Congress. The vast administrative discretion wielded by the executive branch has elevated the power of the president. Republican and Democratic presidents alike have employed an arsenal of administrative tools to pursue their policy goals: high-level appointments, administrative rule making, executive orders, proclamations, memoranda, guidance documents, directives, dear colleague letters, signing statements, reorganizations, funding decisions, and more. Presidents Obama and Trump employed most of these tools in an effort to shape the implementation and outcomes of the Affordable Care Act (ACA) during its first decade. This article focuses on the Obama and Trump administrations' use of comprehensive waivers to shape ACA implementation. The Obama administration had mixed success using waivers to convince Republican states to expand Medicaid. Compared to Obama, the Trump administration has found it harder to accomplish its policy goals through waivers, but if the courts support the Trump administration's work requirement and 1332 waiver initiatives, it would enable the president to use waivers to achieve an ever broader set of goals, including program retrenchment.
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Gullapalli, Bhanu Teja, Stephanie Carreiro, Brittany P. Chapman, Eric L. Garland, and Tauhidur Rahman. "Pharmacokinetics-Informed Neural Network for Predicting Opioid Administration Moments with Wearable Sensors." Proceedings of the AAAI Conference on Artificial Intelligence 38, no. 21 (March 24, 2024): 22892–98. http://dx.doi.org/10.1609/aaai.v38i21.30326.
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Long-term and high-dose prescription opioid use places individuals at risk for opioid misuse, opioid use disorder (OUD), and overdose. Existing methods for monitoring opioid use and detecting misuse rely on self-reports, which are prone to reporting bias, and toxicology testing, which may be infeasible in outpatient settings. Although wearable technologies for monitoring day-to-day health metrics have gained significant traction in recent years due to their ease of use, flexibility, and advancements in sensor technology, their application within the opioid use space remains underexplored. In the current work, we demonstrate that oral opioid administrations can be detected using physiological signals collected from a wrist sensor. More importantly, we show that models informed by opioid pharmacokinetics increase reliability in predicting the timing of opioid administrations. Forty-two individuals who were prescribed opioids as a part of their medical treatment in-hospital and after discharge were enrolled. Participants wore a wrist sensor throughout the study, while opioid administrations were tracked using electronic medical records and self-reports. We collected 1,983 hours of sensor data containing 187 opioid administrations from the inpatient setting and 927 hours of sensor data containing 40 opioid administrations from the outpatient setting. We demonstrate that a self-supervised pre-trained model, capable of learning the canonical time series of plasma concentration of the drug derived from opioid pharmacokinetics, can reliably detect opioid administration in both settings. Our work suggests the potential of pharmacokinetic-informed, data-driven models to objectively detect opioid use in daily life.
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Marmor, Theodore. "The Politics of Universal Health Insurance: Lessons from Past Administrations?" PS: Political Science and Politics 27, no. 2 (June 1994): 194. http://dx.doi.org/10.2307/420269.
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Marmor, Theodore. "The Politics of Universal Health Insurance: Lessons from Past Administrations?" PS: Political Science & Politics 27, no. 02 (June 1994): 194–98. http://dx.doi.org/10.1017/s1049096500040403.
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Davidson, Erica, Simon Lam, and Erick Sokn. "Predictors of Medication Nonadherence From Outpatient Pharmacy Data Within a Large, Academic Health System." Journal of Pharmacy Practice 32, no. 2 (December 18, 2017): 175–78. http://dx.doi.org/10.1177/0897190017748048.
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Background: Medication nonadherence is a worldwide issue that can lead to poor clinical outcomes and increased health-care costs. Objective: To determine the predictors of medication nonadherence. Methods: A retrospective chart review was conducted for patients who received prescription medications from Cleveland Clinic outpatient pharmacies. Prediction variables consisted of demographics, socioeconomic status, number of medications, and number of daily administrations. These variables were analyzed using a logistic regression to determine independent predictors of medication adherence. Results: Between January and September 2015, over 300 000 eligible prescriptions were filled, corresponding with over 70 000 unique patients. Of these, 29 134 patients were included. After multivariable regression, increasing age (odds ratio [OR]: 1.01), household income (OR: 1.03), and medication count (OR: 1.05) were found to be associated with adherence. Male gender (OR: 0.88), African American (OR: 0.45), Hispanic (OR: 0.62), or other race (OR: 0.87), being single (OR: 0.92), and increasing frequency of administrations per day (OR: 0.76) were associated with nonadherence. Conclusion: Medication nonadherence was associated with nonwhite race, single status, male gender, low socioeconomic status, and increasing frequency of medication administration. Based on these results, a risk prediction tool could be created to determine which patients are at the highest risk of medication nonadherence.
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Anagnostakis, A., G. Sakellaris, M. Tzima, D. I. Fotiadis, and A. Likas. "CITATION: Smart Administrations in the Healthcare Sector." Health Informatics Journal 9, no. 2 (June 2003): 67–78. http://dx.doi.org/10.1177/1460458203009002001.
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Sutherland, Adam, William S. Gerrard, Arif Patel, Michelle Randall, and Emma Weston. "The impact of drug error reduction software on preventing harmful adverse drug events in England: a retrospective database study." BMJ Open Quality 11, no. 3 (July 2022): e001708. http://dx.doi.org/10.1136/bmjoq-2021-001708.
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IntroductionThe use of intravenous administration systems with dose error reduction software (DERS) is advocated to mitigate avoidable medication harm. No large-scale analysis of UK data has been attempted. This retrospective descriptive study aimed to estimate the prevalence of hard limit events and to estimate the potential severity of DERS events.MethodTwelve months of DERS data was obtained from two NHS trusts in England. Definitions for drug categories and clinical areas were standardised and an algorithm developed to extract hard maximum (HMX) events. Subject matter experts (SMEs) were asked to rate severity of all HMX events on a scale of 0 (no harm) to 10 (death). These were analysed by clinical area and drug category, per 1000 administrations.ResultsA total of 745 170 infusions were administered over 644 052 patient bed days (PBDs). 45% of these (338 263) were administered with DERS enabled. HMX event incidence across the whole dataset was 17.9/1000 administrations (95% CI 17.5 to 18.4); 9.4/1000 PBDs (95% CI 9.2 to 9.7). 6067 HMX events were identified. 4604 were <2-fold deviations and excluded. HMX were identified in all drug categories. The highest incidence was antibacterial drugs (2.21%; 95% CI 2.13 to 2.29). Of the 1415 HMX events reviewed by SMEs, 747 (52.6%) were low/no harm. Drugs with greatest potential harm were antiarrhythmics (21.8/1000 administrations; 95% CI 16.3 to 29.1), parenteral anticoagulants (24.16/1000 administrations; 95% CI 15.3 to 37.9) and antiepileptics (20.86/1000 administrations; 95% CI 16.4 to 26.5). DERS has prevented severe harm or death in 110 patients in these hospitals. Medical and paediatric areas had higher prevalence of potentially harmful HMX events, but these were probably related to profile design.ConclusionCompliance with DERS in this study was 45%. DERS events are common, but potential harm is rare. DERS events are not related to specific clinical areas. There are some issues with definition and design of drug profiles that may cause DERS events, thus future work should focus on implementation and data standardisation for future large-scale analysis.
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Giromini, Luciano, Claudia Pignolo, Gerald Young, Eric Y. Drogin, Alessandro Zennaro, and Donald J. Viglione. "Comparability and Validity of the Online and In-Person Administrations of the Inventory of Problems-29." Psychological Injury and Law 14, no. 2 (April 5, 2021): 77–88. http://dx.doi.org/10.1007/s12207-021-09406-0.
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AbstractWhile the psychometric equivalence of computerized versus paper-and-pencil administration formats has been documented for some tests, so far very few studies have focused on the comparability and validity of test scores obtained via in-person versus remote administrations, and none of them have researched a symptom validity test (SVT). To contribute to fill this gap in the literature, we investigated the scores of the Inventory of Problems-29 (IOP-29) generated by various administration formats. More specifically, Study 1 evaluated the equivalence of scores from nonclinical individuals administered the IOP-29 remotely (n = 146) versus in-person via computer (n = 140) versus in-person via paper-and-pencil format (n = 140). Study 2 reviewed published IOP-29 studies conducted using remote/online versus in-person, paper-and-pencil test administrations to determine if remote testing could adversely influence the validity of IOP-29 test results. Taken together, our findings suggest that the effectiveness of the IOP-29 is preserved when alternating between face-to-face and online/remote formats.
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Joseph, Roy, Sang Weon Lee, Scott V. Anderson, and Matthew J. Morrisette. "Impact of interoperability of smart infusion pumps and an electronic medical record in critical care." American Journal of Health-System Pharmacy 77, no. 15 (July 4, 2020): 1231–36. http://dx.doi.org/10.1093/ajhp/zxaa164.
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Abstract Purpose To describe the benefits of smart infusion pump interoperability with an electronic medical record (EMR) system in an adult intensive care unit (ICU) setting. Summary In order to assess the impact of smart infusion pump and EMR interoperability, we observed whether there were changes in the frequency of electronic medication administration record (eMAR) documentation of dose titrations in epinephrine and norepinephrine infusions in the ICU setting. As a secondary endpoint, we examined whether smart pump/EMR interoperability had any impact on the rate of alerts triggered by the dose-error reduction software. Pharmacist satisfaction was measured to determine the impact of smart pump/EMR interoperability on pharmacist workflow. In the preimplementation phase, there were a total of 2,503 administrations of epinephrine and norepinephrine; 13,299 rate changes were documented, for an average of 5.31 documented rate changes per administration. With smart pump interoperability, a total of 13,024 rate changes were documented in association with 1,401 administrations, for an average of 9.29 documented rate changes per administration (a 74.9% increase). A total of 1,526 dose alerts were triggered in association with 76,145 infusions in the preimplementation phase; there were 820 dose alerts associated with 48,758 autoprogammed infusions in the postimplementation phase (absolute difference, –0.32%). ICU pharmacists largely agreed (75% of survey respondents) that the technology provided incremental value in providing patient care. Conclusion Interoperability between the smart pump and EMR systems proved beneficial in the administration and monitoring of continuous infusions in the ICU setting. Additionally, ICU pharmacists may be positively impacted by improved clinical data accuracy and operational efficiency.
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Brüchert, Tanja, Paula Quentin, Sabine Baumgart, and Gabriele Bolte. "Barriers, Facilitating Factors, and Intersectoral Collaboration for Promoting Active Mobility for Healthy Aging—A Qualitative Study within Local Government in Germany." International Journal of Environmental Research and Public Health 18, no. 7 (April 6, 2021): 3807. http://dx.doi.org/10.3390/ijerph18073807.
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The promotion of walking and cycling to stay active and mobile offers great potential for healthy aging. Intersectoral collaboration for age-friendly urban planning is required in local government to realize this potential. Semi-structured interviews were conducted with the heads of planning and public health departments in city and district administrations of a Metropolitan Region in Germany to identify factors influencing action on the cross-cutting issue of active mobility for healthy aging. Although some administrations are working on the promotion of active mobility, they consider neither the needs of older people nor health effects. A lack of human resources and expertise, mainly due to the low priority placed on the issue, are described as the main barriers for further strategic collaboration. Furthermore, the public health sector often focuses on pathogens as the cause of morbidity and mortality, reducing their acceptance of responsibility for the topic. Facilitating factors include the establishment of new administrative structures, projects with rapid results that create awareness and credibility among citizens and politicians, additional staff with expertise in health promotion, and political commitment. In the future, new administrative structures for intersectoral collaboration are needed in order to consider various perspectives in complex developments, such as healthy aging, and to benefit from synergies.
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Benítez Llamazares, Nuria. "LA FINANCIACIÓN DE LA SANIDAD PÚBLICA ESPAÑOLA. ESPECIAL REFERENCIA A LA CRISIS SANITARIA GENERADA POR COVID-19." E-REVISTA INTERNACIONAL DE LA PROTECCION SOCIAL 5, no. 2 (2020): 356–72. http://dx.doi.org/10.12795/e-rips.2020.i02.16.
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Health population is considered as a fundamental right according to the Spanish Constitution, and public administrations have the duty to guarantee such benefits. National Health System in Spain is configurated by public structures and Health services at all levels of government. The definition of health care benefits as non-contributory implies that the most appropriate alternative is the tax financing of a high percentage of public health spending. Additionally, other financing mechanisms are possible, such as income from donations to the COVID-19 State, an alternative that has given good results to finance the costs associated with the management of the current pandemic.
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Hennes, Emily R., Michael Reed, Mary Mably, Jason Jared, Jason J. Bergsbaken, Dustin Deming, Natalie Callander, and Ruth O’Regan. "Implementation of a chemotherapy stewardship process." American Journal of Health-System Pharmacy 77, no. 15 (July 4, 2020): 1243–48. http://dx.doi.org/10.1093/ajhp/zxaa157.
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Abstract Purpose To design and implement a chemotherapy stewardship process to optimize the location of chemotherapy administration in an effort to decrease the number of inappropriate inpatient anticancer regimen administrations and decrease institutional costs associated with inpatient administration. Summary As the costs of anticancer agents continue to rise, it is crucial that multidisciplinary efforts are aimed at managing anticancer medication utilization; this is especially important for high-cost medications, medications whose use requires increased monitoring due to safety concerns, and medications that do not exert effects quickly and, as such, can be more appropriately administered in the outpatient setting. It is imperative that pharmacists play a role in managing chemotherapy medication utilization, as pharmacists provide expertise in formulary management, a vast knowledge of financial impact and reimbursement processes, and clinical knowledge that can help predict the expected effectiveness and adverse effects of each anticancer regimen. Our institution sought to develop and implement a multidisciplinary chemotherapy stewardship program targeting the optimization of site of anticancer agent administration with a goal of decreasing both cost and inappropriate utilization of high-cost, high-risk anticancer agents. Conclusion Implementation of a chemotherapy stewardship service may decrease the number of inappropriate inpatient anticancer regimen administrations and decrease inpatient resource use, thereby decreasing costs to institutions. The concept of a chemotherapy stewardship process was well received by multidisciplinary healthcare colleagues, and a collaborative approach should be used to design and implement such processes.
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Prystaya, M. "Public administration in the field of health care peculiarities." Uzhhorod National University Herald. Series: Law 1, no. 80 (January 22, 2024): 557–62. http://dx.doi.org/10.24144/2307-3322.2023.80.1.85.
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The article examines the peculiarities of administration in the field of health care through the definition of the concept of public administration in the field of health care, its object(s), subject(s), and goals.
It was determined that public administration should be understood as the activity of subjects of public administration, which consists in establishing, changing or terminating the rights and obligations of private individuals for the purpose of ordering and organizing social relations to implement the decisions of the legislative body. Public administration can be expressed through the adoption of normative acts, administrative acts, as well as the execution of legally significant actions.
It has been established that in scientific works of legal direction and public administration, health care and the medical field are often considered as an object of public management (administration). However, for the purposes of legal research, the object of public administration is defined as the sphere or branch of health care in which various subjects interact: public authorities, health care institutions, patients, legal entities, medical workers, administration of institutions, etc. And the goal of public administration is to achieve the appropriate level of organization of activities of subjects in the field of health care. At the same time, the subjects of legal relations in the field of health care can simultaneously act as objects of administration, if the legal relations are considered from the standpoint of administrative and legal regulation.
Accordingly, a health care institution is a separate object of public administration, which is directed to the goal-setting, organizing, as well as regulatory activities and influence of administration subjects (state bodies, local self-government bodies, administrations of the institutions themselves). Therefore, in the future research, the terms “administration (management) in the field of health care”, “administration (management) of a health care institution” will be used.
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Danylenko, Yevhen S. "The Public Procurement of Passenger Cars in Ukraine." PROBLEMS OF ECONOMY 4, no. 54 (2022): 35–45. http://dx.doi.org/10.32983/2222-0712-2022-4-35-45.
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The article presents the most popular models of passenger cars among authorities, institutions and organizations. The author provides information on the volume of purchases and total costs of cars of different brands and autobody types by authorities, institutions and organizations from January to October 2022. It is found that the largest number of passenger cars was purchased by law enforcement agencies, health care institutions, housing and communal services enterprises, and the State administration bodies. The most popular models were Renault Duster, Renault Express, Toyota RAV4, Renault Sandero Stepway Life+, Haval Jolion. The most popular were: among crossovers – the Renault Duster, among sedans – Peugeot 301, among the SUV – Toyota RAV4, among the hatchbacks – Renault Sandero Stepway Life+, among the station-wagons – ?koda Superb and Renaut Megan, among the vans – Fiat Doblo Combi Mahi, among the minivans – Renault Express, among the minibuses – Mercedes-Benz sprinter 313. Renault cars are most demanded. The most popular autobody types are crossover, hatchback and SUV. Sedans are popular in law enforcement agencies, health care facilities, housing and communal services. Crossovers are most in demand in law enforcement agencies, health care institutions, and the State administrations. Hatchbacks are in demand in law enforcement and healthcare facilities. The SUVs are of greatest popularity in law enforcement agencies, housing and communal services enterprises, and the State administrations. The main buyer of the vans are the State administrations, health care institutions, and housing and communal services enterprises. Minivans are used by law enforcement agencies and housing and communal services enterprises. The author estimates that in 2022, through the Prozorro public procurement website, government agencies spent UAH 234.003 million on the purchase of passenger cars.
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Procaccini, David E., and Sapna R. Kudchadkar. "Melatonin Administration Patterns for Pediatric Inpatients in a Tertiary Children’s Hospital." Hospital Pediatrics 11, no. 11 (November 1, 2021): e308-e312. http://dx.doi.org/10.1542/hpeds.2021-006117.
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OBJECTIVES Melatonin has been trialed with reported increasing use for sleep dysregulation and prevention of ICU delirium in critically ill adults; however, reports of use in hospitalized pediatric patients are limited. We anecdotally observed an increase in prescribing of melatonin in our tertiary care children’s hospital and therefore aimed to retrospectively characterize prescribing practices over time. METHODS Melatonin dispensing data over a 4-year time frame were extracted. Melatonin doses were categorized as being either ICU or non-ICU administered and dosed during daytime versus nighttime, respectively. Descriptive statistics were used to characterize patients who were administered melatonin, dosing information, and quantitative change in annual melatonin orders between areas. The comparison of daytime versus nighttime melatonin administrations and ratio of administrations between ICU and non-ICU areas for each study year were compared via χ2 test. RESULTS Administration of melatonin increased 246.2% between years 1 and 3, with a shift from predominance in ICU to non-ICU areas over the study period (P < .0001). The average dosing varied by age, with the most frequent dose being 5 mg (28.3%), predominantly in patients ≥12 years of age. Ninety-eight percent (n = 9434) of doses were scheduled for nighttime administration, suggesting an indication of sleep regulation. There were significantly more daytime administrations of melatonin in non-ICU areas (P < .0001). CONCLUSIONS Prescribing of melatonin for pediatric inpatients has increased substantially over a 4-year period, despite limited research on dosing, in this single-center. Further research is needed to determine best practices for melatonin prescribing for hospitalized children.
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DuBeshter, Brent, Carolyn J. Walsh, Kim Altobelli, John Loughner, and Cynthia Angel. "Experience With Computerized Chemotherapy Order Entry." Journal of Oncology Practice 2, no. 2 (March 2006): 49–52. http://dx.doi.org/10.1200/jop.2006.2.2.49.
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Purpose The elimination of errors related to chemotherapy administration remains an elusive goal. Computerized order entry has been shown to reduce errors. We assessed a chemotherapy computer order entry system for errors related to dosing and for the time required to prepare chemotherapy orders. Methods A prospective study of all patients treated with chemotherapy over a 12-month period was performed. Chemotherapy order sets done via computerized order entry were reviewed for errors related to drug selection, dose calculations, decimal-point errors, and for exceeding a warning level set within the system. We also measured the time required to produce three order sets by hand versus by computer. Results There were no errors in dose calculations, decimal points, or drug selection for 2,558 drug administrations in 235 patients treated with 26 different chemotherapy regimens. The dose warning level was exceeded in 152 (6%) of drug administrations, but never without user permission to override the warning. The average time saved per order set using computer order entry was 10 minutes (P < .05). Conclusion By using computer order entry with error-checking algorithms, it may be possible to eliminate a number of types of errors associated with chemotherapy administration without sacrificing efficiency.
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Kolosok, Svitlana, and Agnieszka Jakubowska. "COVID-19 And Public Health Administration: Trends And Prospects." Health Economics and Management Review 1, no. 1 (2020): 69–75. http://dx.doi.org/10.21272/hem.2020.1-06.
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This paper provides a bibliographic analysis of the scientific background devoted to public health administration prospects regarding spreading coronavirus disease worldwide. The study sample consists of 1240 scientific documents on public health administration published from 2015 to 2021. The search of relative documents was conducted by the keyphrase «public health administration» in the document titles, abstracts and keywords. The publications’ source is the Scopus database. The software VOSviewer version 1.6.15 was used to visualize the network map of keywords co-occurrences under the restriction of at least 40 keyword occurrences in the study sample. The obtained results allowed identifying four clusters indicating the research directions of investigated publications. Therefore, the first cluster is focused on gender and age differences. The author found that these documents were published mostly in 2018. The second cluster indicated the current research direction in investigating public health administrations and COVID-19. The author noted the growing scientists’ interest in coronavirus infection issues, virus pneumonia, coronavirus disease 2019, disease outbreaks and COVID-19 since 2020. Moreover, the scientists were interested in studying the planning and control of the coronavirus incidence regarding proper health administration. The third cluster indicated researching health policy, especially health care policy, health care planning, health care delivery, and health equity. In turn, the fourth cluster is the most powerful by keyword links in the study sample. The author noted that the fourth cluster is the most powerful by keyword links. This cluster consists of 28 terms, while the most important terms by link strengths are public health administration, public health service. Besides, it indicates the research direction on procedures, standards, organization, and public health management. The obtained results allowed assuming that further studies would be devoted to healthcare institutions’ administration and financial provision, vaccination against COVID-19 and assessing its impact.
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Utama, I. Gusti Bagus Rai, I. Wayan Ruspendi Junaedi, Ni Putu Dyah Krismawintari, Jaya Pramono, and I. Nengah Laba. "New Normal Acceleration Strategy for Bali Tourism Destination Recovery with E-Tourism and Special Health Protocol for the Tourism Sector." Technium Social Sciences Journal 10 (July 28, 2020): 156–66. http://dx.doi.org/10.47577/tssj.v10i1.1332.
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Virtual tourism is accepted make an advantage for bosses small scale of travel industry through the offer of access administrations, however, all in large scale virtual tourism will affect essentially on the travel industry goals in the truth of the experience since they can't be provided by the supplier. Virtual tourism just give looks and impressions, yet unfit to give a taste, smell, feeling, fulfillment, dedication, and dependability. Arranging a traveler visit may utilize different proposals offered by different suppliers. For booking travel tickets inside the nation, traveloka will be their decision with different advantageous installment choices gave. For booking global travel tickets they may pick TripAdvisor. For the choice of goals to be visited, potential sightseers will no doubt utilize the suggestions offered by Indonesia Virtual Tour, and Tripadvisor may be for determination of facilities, imminent travelers get more suggestions, however, who can show evaluations that are probably going to be trailed by expected voyagers. Regardless of how straight forward virtual tourism is, they have a significant job as an extension between the travel industry makers and likely voyagers. E-tourism created in Indonesia right now has not addressed the most significant part of giving data and assurance to sightseers when they decide to visit vacationer goals. The vast majority of the suppliers that fabricate virtually the travel industry frameworks have the point of building up a business association or business affiliations with entrepreneurs, for example, convenience administrations, tagging administrations, eatery administrations, and different administrations focused on business. Another technique arranged to quicken the recuperation of Bali's travel industry is to make and set explicit wellbeing gauges. Explicit Health Standards arranged for the travel industry as expressed in Circular Letter Number 3355 of 2020 concerning the new ordinary Protocol for the Bali Tourism Sector.
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Herbert-Maul, Annika, Karim Abu-Omar, Anna Streber, Zsuzsanna Majzik, Jeanette Hefele, Stephanie Dobslaw, Hedi Werner, Alexandra Wolf, and Anne K. Reimers. "Scaling Up a Community-Based Exercise Program for Women in Difficult Life Situations in Germany—The BIG Project as a Case-Study." International Journal of Environmental Research and Public Health 18, no. 18 (September 7, 2021): 9432. http://dx.doi.org/10.3390/ijerph18189432.
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Scaling up community-based participatory research (CBPR) remains challenging. This case-study reports on how, and under which conditions, a CBPR project aiming at promoting exercise among socially disadvantaged women (BIG) scaled up at four project sites. As part of BIG, researchers support city administrations in implementing a participatory project to reach socially disadvantaged women for exercise. The case study was conducted in winter 2020 in southern Germany and is based on a co-creative process involving city administrators and researchers. Following Kohl and Cooley’s scaling up dimensions, scaling up BIG was investigated at the four sites using a mixed-method approach. Course registrations and offers were analysed, and qualitative interviews (n = 4) with administrative staff members were conducted and analysed using content analysis. The geographical coverage of exercise classes, the addressed groups, and the utilisation of participatory methods by city administrations are described. All four sites managed to scale-up project activities. Three of the four sites reported that further growth of the project was no longer possible due to limited resources. All sites attempted to reach a larger number of, and more diverse, women. One site managed to scale-up the use of participatory methods within the city administration. The following important facilitators for scaling up CBPR projects were reported: advertisements tailored to the needs of the addressed women, utilising participatory approaches, and equipping project coordinators with sufficient resources.
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Raja, Hina Zafar, Muhammad Nasir Saleem, Ayesha Noor, Ayesha Usmani, and Junaid S. Khan. "Status of Research and Development Within Dental Institutes of Pakistan." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 59 (January 2022): 004695802211001. http://dx.doi.org/10.1177/00469580221100147.
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Health sector institutes of Pakistan can play a pivotal part in improving the status of health sciences. This can be achieved by facilitating research and innovation facilities. It is a need of the day to emphasize academicians and institutional administrations to take keen interest in this regard. Knowledge of the present research and development conditions within higher education institutions may help in policy development and fund allocations at the required levels. Therefore, the objective of this study is to evaluate the status of research and development within dental Institutes of Pakistan. A 30 itemed questionnaire was e mailed/posted to all institutional heads of all registered and recognized dental institutes of Pakistan. Response rate was 62% showing lack of administrational interest. Insufficient infrastructure, inadequate research planning, execution and intellectual property management was recorded. It can be concluded that higher education dental institutions of Pakistan are in need of deeper administrational and educational input to gear up the progress of health sector in this direction.
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Balzamo, E., D. Lagarde, C. Milhaud, E. Mocaer, and JC Poignant. "Effects of tianeptine on sleep-wakefulness cycles in the rhesus monkey." European Psychiatry 8, no. 1 (1993): 35–40. http://dx.doi.org/10.1017/s0924933800001528.
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SummaryRepeated administrations of tianeptine (10 mg·kg-1 im, twice daily, for 15 days) did not globally influence sleep-wakefulness cycles and cortical EEG activity overnight in rhesus monkeys. This antidepressant agent neither inhibited paradoxical sleep nor increased slow wave sleep. However, tianeptine induced a slight, but significant increase in wakefulness during the first hour following its administration, and had no sedative effects. The influence of tianeptine on sleep patterns in the monkey could be related to other arousal or sleep modifications observed in rats and cats, and to certain electrophysiological data reported in rat studies.
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Smith, Christina J., Caroline M. Sierra, Joanna Robbins, Nancy Y. Chang, and Farrukh Mirza. "Methylnaltrexone for Opioid-Induced Dysmotility in Critically Ill Infants and Children: A Pilot Study." Journal of Pediatric Pharmacology and Therapeutics 28, no. 2 (April 1, 2023): 136–42. http://dx.doi.org/10.5863/1551-6776-28.2.136.
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OBJECTIVE Critically ill pediatric patients commonly experience opioid-induced dysmotility. Methylnaltrexone, a subcutaneously administered, peripherally acting mu-opioid receptor antagonist, is a compelling adjunct to enteral laxatives in patients with opioid-induced dysmotility. Data for methylnaltrexone use in critically ill pediatric patients are limited. The purpose of this study was to determine the effectiveness and safety of methylnaltrexone for opioid-induced dysmotility in critically ill infants and children. METHODS Patients younger than 18 years who received subcutaneous methylnaltrexone from January 1, 2013, through September 15, 2020, in the pediatric intensive care units at an academic institution were included in this retrospective analysis. Outcomes included incidence of bowel movement, enteral nutrition feeding volume, and adverse drug events. RESULTS Twenty-four patients, median age 3.5 years (IQR, 0.58–11.1), received 72 methylnaltrexone doses. The median dose was 0.15 mg/kg (IQR, 0.15–0.15). Patients were receiving a mean ± SD of 7.5 ± 4.5 mg/kg/day of oral morphine milligram equivalents (MMEs) at methylnaltrexone administration and received opioids for median 13 days (IQR, 8.8–21) prior to methylnaltrexone administration. A bowel movement occurred within 4 hours following 43 (60%) administrations and within 24 hours following 58 (81%) administrations. Enteral nutrition volume increased by 81% (p = 0.002) following administration. Three patients had emesis and 2 received anti-nausea medication. No significant changes in sedation or pain scores were observed. Withdrawal scores and daily oral MMEs decreased following administration (p = 0.008 and p = 0.002, respectively). CONCLUSIONS Methylnaltrexone may be an effective treatment for opioid-induced dysmotility in critically ill pediatric patients with low risk of adverse effects.
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Landekić, Matija, Ivan Martinić, David Mijoč, Matija Bakarić, and Mario Šporčić. "Injury Patterns among Forestry Workers in Croatia." Forests 12, no. 10 (October 6, 2021): 1356. http://dx.doi.org/10.3390/f12101356.
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Timber harvesting, especially motor-manual felling, in Croatia, as in many other countries, is one of the most hazardous economic activities. Consequently, the aim of this paper is to analyse and compare the latest trends and risk factors related to the incidence of work-induced injuries in structural organization units of national forest enterprise. A combined approach of literature review and assembled secondary data was applied to gather data on workplace accidents over the years 2014–2020. Work-induced injuries data were drawn from the records of the national enterprise Croatian Forests Ltd. which manages state forests (76% of total forest area). A total of 1626 work-induced injuries were processed and entered into the database. Data analysis was conducted using statistical and descriptive methods. Research results have proven a significant difference in the injury rate over the years 2014–2020 in the Croatian forest enterprise. During the analysed period the highest number of workplace accidents (51.35% of all recorded workplace accidents) occurred during the forest harvesting phase, i.e., during motor-manual felling. Trends in the incidence of work-induced injuries in the observed period do not show any significant improvement. The key findings have pointed out that forest administrations which practice even-aged forest management have 25% or more injuries than forest administrations which practice selective forest management. Related to the average rate of change by forest administration, the largest annual increase or decrease of the selected safety indicators is recorded for smallest forest administrations. Related to total number of injuries, the smallest forest administrations have the least injuries and show statistically significant difference compared to large forest administrations. When comparing the number of injuries per 1000 employees, medium sized forest administrations have the highest value of indicator and show statistical significance. Discussion and conclusion of the paper emphasizes the need for systematic research in the field of ergonomy, safety and health of forest workers in Croatian forestry sector. Additionally, the development and inclusion of proactive safety culture is recognized as a mechanism that can further reduce work injuries and improve occupational safety which should have a significant role in the process of certification of forest management according to the FSC standard.
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London, Jack W., Julia ORourke, Jeff Warnick, John Doole, Luc De Keyser, Zuzanna Drebert, Olivia Wan, Courtney Thompson, and Matvey Palchuk. "Deriving breast cancer chemotherapy patterns from real-world data." Journal of Clinical Oncology 41, no. 16_suppl (June 1, 2023): e13586-e13586. http://dx.doi.org/10.1200/jco.2023.41.16_suppl.e13586.
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e13586 Background: Real World Data (RWD) collected during routine medical practice can help in clinical trial design, planning and execution. In addition, it can provide a compelling picture of safety of medical products, and account for all potential adverse events that can be encountered in routine clinical practice. However, raw drug information about chemotherapy in cancer care is not readily understandable in the format it is collected. Analytical techniques need to be applied to extract regimen information, which includes drugs, dosage, number of cycles and cycle length. Methods: A retrospective study was performed using data on 7,798 breast cancer patients from the TriNetX Network, a federated network of de-identified, HIPAA-compliant, health data from 21 healthcare organizations across North America as of May 2022. We investigated a method built on rule-based algorithm and clustering analysis to extract regimens and their patterns of administration and align them into lines of treatment (LOT). To derive drug administration patterns, we clustered administration time periods using three features: total number of drug administrations, median number of days between drug administrations, and standard deviation of the days between drug administrations. Results: The patterns of administration that correspond to the two most common regimens for Erb-B2 receptor tyrosine kinase 2 negative group (ERBB2-) stages 1, 2 and 3 are shown. We looked at patients with Hormone Receptor (HR+) positive and Triple Negative (TN) breast cancer. Results of our analysis were in a close agreement with NCCN Guidelines. However, regimen administration patterns varied. This information can be useful to characterize patients based on the adherence to the expected chemotherapy regimens. It can also provide meaningful insight into burden of illness, such that patients who have higher variability of the drug administration might be faced with clinical problems such as drug tolerability or side effects. The variability might also signify access to care challenges. Conclusions: Understanding regimen LOT and administration patterns is central to research based on RWD, but it can also be useful for clinical trial design, execution, as well as site selection and patient recruitment for clinical trials. [Table: see text]
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Panchatcharam, Parthasarathy, and Vivekanandan S. "Internet of Things (IOT) in Healthcare – Smart Health and Surveillance, Architectures, Security Analysis and Data Transfer." International Journal of Software Innovation 7, no. 2 (April 2019): 21–40. http://dx.doi.org/10.4018/ijsi.2019040103.
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Wellbeing is fundament requirement. What's more, it is human appropriate to get quality health care. These days, India is confronting numerous medical problems in light of fewer assets. This survey article displays the idea of solving health issues by utilizing a recent innovation, the Internet of Things (IOT). The Internet of Things with their developing interdisciplinary applications has changed our lives. Smart health care being one such IoT application interfaces brilliant gadgets, machines, patients, specialists, and sensors to the web. At long last, the difficulties and prospects of the improvement of IoT-based medicinal service frameworks are talked about in detail. This review additionally summarizes the security and protection worries of IoT, administrations and application of IoT and smart healthcare services that have changed the customary medicinal services framework by making healthcare administration more proficient through their applications.
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Faro, L. R. F., R. Durán, J. L. M. Do Nascimento, D. Perez-Vences, and M. Alfonso. "Effects of successive intrastriatal methylmercury administrations on dopaminergic system." Ecotoxicology and Environmental Safety 55, no. 2 (June 2003): 173–77. http://dx.doi.org/10.1016/s0147-6513(02)00127-6.
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Salces Rodrigo, M. T. "Child and Youth mental health: analysis from an institution guarenteeing rights." Cuadernos de Medicina Forense 26, no. 26(01) (June 2023): 41–47. http://dx.doi.org/10.59457/cmf.2023.26.01.org03.
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The aim of this article is to analyze the mental health problems of children and adolescents from the perspective of an Institution entrusted by Law 4/2021, of 27 July, on Children and Adolescents of Andalusia, to be the guarantor of the defense of the rights and freedoms of this particularly vulnerable sector of society. It will address, first, main problems and challenges affecting these children with mental health problems, taking into account the experience of the Ombudsman’s Office in the complaints received from those affected, their families or associations in the sector. Claims that, on the other hand, have been increased after the pandemic caused by Covid-19. Protecting and defending the rights of children also involves formulating proposals for improvements to be taken into consideration by public administrations. Therefore, the document also contains a compendium of those suggestions and recommendations that the Ombudsman has addressed to the Administration of the Andalusian Regional Government to improve the quality of care offered to children suffering from any mental pathology.
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Clouser, Amanda A., Cristian D. Merchan, Ferras Bashqoy, Joanna L. Tracy, John Papadopoulos, and Anasemon Saad. "Evaluation of Parenteral Potassium Supplementation in Pediatric Patients." Journal of Pediatric Pharmacology and Therapeutics 28, no. 1 (January 1, 2023): 48–54. http://dx.doi.org/10.5863/1551-6776-28.1.48.
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OBJECTIVE The primary objective was to evaluate the effect of parenteral potassium chloride (KCl) supplementation on potassium (K+) concentrations in a non-cardiac pediatric population. Secondary outcomes were to identify variables that may influence response to KCl supplementation (i.e., change in K+ concentration after KCl administration) and assess the incidence of hyperkalemia. METHODS This single-center, retrospective study evaluated infants and children who received parenteral KCl supplementation of 0.5 or 1 mEq/kg between January 2017 and December 2019. RESULTS The study included 102 patients with a median age of 1 year (IQR, 0.4–3.9) and weight of 9.1 kg (IQR, 4.9–14.2) who received 288 parenteral KCl administrations. One hundred seventy-three administrations were in the 1 mEq/kg group, and 115 administrations were in the 0.5 mEq/kg group. The median changes in K+ were 0.8 and 0.5 mEq/L in the 1 mEq/kg and 0.5 mEq/kg groups, respectively. Patients who had a repeat K+ concentration within 4 hours of the end of a 1 to 2–hour infusion had a higher median change in K+ compared with those who had a concentration drawn after this time frame (0.8 vs 0.6 mEq/L; p < 0.01). CONCLUSIONS There is a paucity of data on the correlation between parenteral KCl supplementation and change in K+ concentrations in pediatric patients. Our study demonstrated an association between KCl supplementation doses of 1 and 0.5 mEq/kg and changes in K+ of 0.8 and 0.5 mEq/L, respectively, in non-cardiac pediatric patients, with low observed incidence of hyperkalemia.
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Oliveira, Fernanda Piana Santos Lima de, Andrea Maria Duarte Vargas, Zulmira Hartz, Sónia Dias, and Efigênia Ferreira e. Ferreira. "Integration of School Health Program actions among health and education professionals: a case study in Belo Horizonte, Minas Gerais." Saúde em Debate 46, spe3 (November 2022): 72–86. http://dx.doi.org/10.1590/0103-11042022e305i.
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ABSTRACT The School Health Program aims to build healthy schools. This qualitative case study aimed to identify and understand how professionals involved in the School Health Program behave in the integration based on their inclusion in the recommended activities. The consensus was reached with experts to develop a matrix of indicators after building the Program’s logical model, resulting in a semi-structured roadmap. Twenty-five interviews were held in the Basic Health Units, Elementary Schools, and the Regional Health and Education Administrations. The practices were multisectoral, with no combined efforts and effective co-participation, planned by a single sector or professional, the existing gaps are recognized as much as the importance of the program, and the practices are implemented with a low bond between teams. The fragmented perception of students’ problems hinders this integration.
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Bhumiratana, Adisak, Apiradee Intarapuk, Suriyo Chujun, Wuthichai Kaewwaen, Prapa Sorosjinda-Nunthawarasilp, and Surachart Koyadun. "Thailand Momentum on Policy and Practice in Local Legislation on Dengue Vector Control." Interdisciplinary Perspectives on Infectious Diseases 2014 (2014): 1–11. http://dx.doi.org/10.1155/2014/217237.
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Over a past decade, an administrative decentralization model, adopted for local administration development in Thailand, is replacing the prior centralized (top-down) command system. The change offers challenges to local governmental agencies and other public health agencies at all the ministerial, regional, and provincial levels. A public health regulatory and legislative framework for dengue vector control by local governmental agencies is a national topic of interest because dengue control program has been integrated into healthcare services at the provincial level and also has been given priority in health plans of local governmental agencies. The enabling environments of local administrations are unique, so this critical review focuses on the authority of local governmental agencies responsible for disease prevention and control and on the functioning of local legislation with respect to dengue vector control and practices.
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Feinberg, Bruce, Lee S. Schwartzberg, James Gilmore, Sally Haislip, James Jackson, Gagan Jain, Sanjeev Balu, and Deborah Buchner. "Likelihood of a Subsequent Chemotherapy Induced Nausea and Vomiting Event In Patients with Hematologic Malignancies Receiving Chemotherapy." Blood 116, no. 21 (November 19, 2010): 3819. http://dx.doi.org/10.1182/blood.v116.21.3819.3819.
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Abstract Abstract 3819 Objective: Chemotherapy induced nausea and vomiting (CINV) is a common side effect and can have a substantial impact on patient quality of life and subsequent health-related resource utilization. In addition to other risk factors including chemotherapy emetogenicity, patient age, gender, and alcohol use, patients with prior history of CINV may have an increased risk of CINV. This study assessed the increased likelihood of a subsequent CINV following a first chemotherapy administration CINV in patients with a hematologic cancer diagnosis receiving single-day low emetogenic chemotherapy (LEC), moderately emetogenic chemotherapy (MEC), or high emetogenic chemotherapy (HEC). Methods: A retrospective analysis was conducted utilizing a merged data set comprised of Georgia Cancer Specialists, Florida Cancer Specialists, and ACORN's electronic medical records databases (April 2006 – June 2010). Patients with any hematologic malignancy (those diagnosed with any leukemia, lymphoma, and/or myeloma (ICD-9-CM 200.xx-208.xx) who received at least two single-day chemotherapy administrations (oral or intravenous) and had no chemotherapy 3 months prior to first chemotherapy administration [index date] were included. Two cohorts: 1) patients with a first chemotherapy administration CINV event and 2) those with no first chemotherapy administration CINV event, were identified and followed for six months. Uncontrolled CINV events were identified through ICD-9-CM codes [nausea and vomiting (N&V)], CPT codes (hydration), rescue medications, N&V hospitalizations, and/or antiemetic therapy after last chemotherapy administration of the cycle. A multivariate logistic regression was conducted to assess the likelihood of subsequent CINV. The model controlled for differences in demographic and clinical variables between the two cohorts including age, gender, Charlson comorbidity index, number of chemotherapy administrations, days between chemotherapy administrations, anti-emetic prophylaxis use with first chemotherapy administration, and chemotherapy emetogenicity. Result: A total of 1,121 patients met the inclusion criteria; 247 (22.0%) experienced a CINV within six months. Of those patients with CINV, 68 patients (27.5%) encountered a CINV event with the first chemotherapy administration. These 68 patients were younger [55.9 (SD: 16.5) vs. 60.8 (SD: 16.1) years; p=0.016] and had fewer chemotherapy administrations [6.4 (SD: 3.0) vs. 8.1 (SD: 5.9); p=0.0189] as compared to patients with no CINV with the first chemotherapy administration. Unadjusted subsequent CINV rate was higher for patients with first chemotherapy administration CINV (33.8% vs. 17.0%; p=0.0005) as compared to patients without a CINV event during first chemotherapy administration. After controlling for differences in covariates, patients with first chemotherapy administration CINV were 2.8 times more likely to have a subsequent CINV compared to patients without a first chemotherapy administration CINV [Odds Ratio (OR): 2.84 (95% CI: 1.63 – 4.96); p=0.0002]. Conclusion: In this retrospective analysis using merged electronic medical records data, patients with hematologic malignancies receiving single-day chemotherapy who had a first chemotherapy administration CINV event were at increased risk of a subsequent CINV event versus those without a CINV event during the first chemotherapy administration. Disclosures: Jackson: Xcenda: Xcenda received funding to conduct the study. Jain:Xcenda: Xcenda received funding to conduct the study. Balu:Eisai, Inc.: Employment. Buchner:Eisai, Inc: Employment.
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Mahdi Mohsen Elias and Bashar salah Gabar. "Attitudes of School Administrations Towards Physical EducationLesson in Light of the Emerging Covid-19 Pandemic and Its Consequences." Mustansiriyah Journal of Sports Science 3, no. 3 (February 12, 2024): 133–40. http://dx.doi.org/10.62540/mjss.2021.03.03.13.
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The current study sheds light on knowing the trends of primary school administrations towards activating the physical education lesson within the curriculum approved by the Education Committee according to the decisions regarding canceling some unnecessary school curricula from the point of view of the crisis cell and the Ministry of Education, as the problem emerged through follow-up and observation until the cancellation Physical education study causes some problems and disturbances for the physical education teacher as a functional aspect, considering that he is entrusted with an educational curriculum on the one hand, and the problem of students complaining about not practicing sports during their time in the school and boredom from scientific lessons on the other hand, and as much as the matter related to the school administration by stating its opinion about the importance of studying physical education And the possibility of placing it within the daily schedule, even for one lesson and for each stage, and it does not affect the time of the remaining subjects or the health of the students. The researchers used the descriptive approach for its suitability and the nature of the research, and the research community consisted of the primary schools administrations of the Baghdad Education Directorate, Rusafa Al Thani / Municipalities Sector, whose number is (54) schools. As for the research sample, it included (50) departments, as the sample was randomly selected with a percentage of (93) %). Then the results are presented, analyzed and discussed by using appropriate statistical means. The two researchers reached some conclusions from the most important trends of school administrations that were positive towards studying physical education, and the researcher recommended the need to pay attention to the study of physical education as it develops and develops the health, psychological and social factor of schoolchildren
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Joyce, Andrew, Emma Risely, Celia Green, Gemma Carey, and Fiona Buick. "What Can Public Health Administration Learn from the Decision-Making Processes during COVID-19?" International Journal of Environmental Research and Public Health 21, no. 1 (December 20, 2023): 4. http://dx.doi.org/10.3390/ijerph21010004.
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Human decision-making is prone to biases and the use of heuristics that can result in making logical errors and erroneous causal connections, which were evident during COVID-19 policy developments and potentially contributed to the inadequate and costly responses to COVID-19. There are decision-making frameworks and tools that can improve organisational decision-making. It is currently unknown as to what extent public health administrations have been using these structured organisational-level decision-making processes to counter decision-making biases. Current reviews of COVID-19 policies could examine not just the content of policy decisions but also how decisions were made. We recommend that understanding whether these decision-making processes have been used in public health administration is key to policy reform and learning from the COVID-19 pandemic. This is a research and practice gap that has significant implications for a wide range of public health policy areas and potentially could have made a profound difference in COVID-19-related policy responses.
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Jensen, Chelsee Jo, Theresa Honsey, Michaela K. Thielen, Mari S. Spitale, Bethany J. Marlette, Erika Kennedy, Rachel L. Olson, and Danielle J. O’Laughlin. "Clicks away from reduced healthcare expenditures: leveraging the electronic health record to reinforce education efforts." BMJ Health & Care Informatics Online 29, no. 1 (December 2022): e100669. http://dx.doi.org/10.1136/bmjhci-2022-100669.
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ObjectivesLupron 11.25 mg has both a narrow indication and a high cost compared to other Lupron presentations. Prior to our study initiation there was no clear distinction between presentations when ordering within the health-system’s Electronic Health Record (EHR). This resulted in inappropriate product selection, payment and billing errors that negatively impact our healthcare system. To reinforce prior education efforts, a new approach was considered leveraging the EHR with information to steer prescribers to the proper Lupron presentation based on indication. This study aimed to reduce off-label prescribing for Lupron 11.25 mg (NDC 00074-3663-03) by 25% by 02/28/2022 without negatively impacting the insurance collection rate.MethodsBaseline Lupron 11.25 mg adult kit administrations one year prior to intervention and off-label prescribing was found to account for 22.7% of administrations. In December 2021 intervention order questions were added to Lupron 11.25 mg in the EHR. One and two-month data was obtained after implementing order questions within the EHR. Lupron 11.25 mg administrations were classified into one of four categories to determine impact on off-label prescribing.ResultsIn the one- and two-month post-implementation periods off-label prescribing was 0% and 15.3% respectively, a reduction of 22.7% to and 7.4% respectively from the baseline assessment. There were no clinical denials found in either post-implementation reporting period.ConclusionThis report adds to the body of evidence that leveraging the EHR can lead to healthcare savings and illustrates how patient and healthcare system burden can be reduced by prompting thought and direction when a medication has indication specific dose requirements.